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Background There is limited information on rates of STIs in Jamaica due to syndromic management and limited aetiological surveillance. We examined the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) and characteristics associated with STIs among sexually active women who participated in a randomised trial of a progestin implant initiation in Jamaica (the Sino-Implant Study (SIS)). Methods SIS was a randomised trial conducted in Kingston, Jamaica, from 2012 to 2014 to evaluate whether initiation of the Sino-Implant (II) led to more unprotected sex among women ages 18–44 years. Data collected included self-reported demographic, sexual behaviour information; and vaginal swabs collected at baseline, 1-month and 3-month follow-up visits for a biomarker of recent semen exposure (prostate-specific antigen (PSA)) and for STIs. We examined associations between STIs and PSA, demographics, sexual behaviour and insertion of an implant, with a repeated-measures analysis using generalised estimating equations (SAS Institute, V.9.3). Results Remnant vaginal swabs from 254 of 414 study participants were tested for STIs. At baseline, 29% of participants tested for STIs (n=247) had laboratory-confirmed CT, 5% NG, 23% TV and 45% any STI. In a repeated-measures analysis adjusted for study arm (immediate vs delayed implant insertion), those with PSA detected did not have an increased prevalence of any STI (prevalence ratio (PR)=1.04 (95% CI 0.89 to 1.21)), whereas prevalence decreased for each 1-year increase in age (PR=0.98 (95% CI 0.97 to 0.99)). Immediate implant insertion was not associated with increases in any STI in subsequent visits (PR=1.09 (95% CI 0.94 to 1.27)). Conclusions Although the prevalence of laboratory-confirmed STIs was high, the immediate initiation of a contraceptive implant was not associated with higher STI prevalence rates over 3 months. Trial registration number NCT01684358.

Background Management of cervicitis and abnormal vaginal discharge in Jamaica is based on the syndromic approach recommended by the WHO. To evaluate current algorithms for treatment of gonorrhoea, chlamydial infection and trichomoniasis, we conducted laboratory testing with vaginal specimens from women presenting with cervicitis or vaginitis syndromes at a sexually transmitted infections clinic in Kingston and at follow-up to assess cure rates for these infections. Methods From August, 2010 through January, 2011, vaginal swab specimens were obtained from 258 women >18 years old during a routine clinical examination prior to syndromic treatment according to local guidelines. Treatment for gonorrhoea, chlamydial infection and trichomoniasis was prescribed for women with cervicitis. Treatment for trichomoniasis, bacterial vaginosis and candidiasis was prescribed for women with abnormal vaginal discharge. Women returned the next week for follow-up assessment and specimen collection. Specimens were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using APTIMA Combo2 and for Trichomonas vaginalis (TV) using APTIMA analyte-specific reagents. All baseline specimens were tested. Follow-up specimens from women with a positive baseline test or who remained symptomatic were also tested. Patients with a positive follow-up test were contacted and instructed to return to the clinic for additional treatment. Cure was defined as a positive baseline test and a negative follow-up test. Results Baseline prevalence of infection with NG was 11.7%, CT was 20.7%, TV was 25.6%. At least one of these STIs was detected by laboratory testing in 40.7% of women. Co-infections were common. Women with TV were more likely to have NG or CT than women without TV (OR: 2.6, 95% CI 1.4 to 4.8). STI testing at follow-up indicated cure rates of 77.3% for NG, 43.5% for CT and 47.1% for TV infections. CT incidence at follow-up was 5.9%; no incident NG or TV infections were detected. Conclusions With syndromic management, just over half of the STIs in women that were detected by laboratory testing at baseline were cured at follow-up. Reinfection, incorrect or inadequate treatment, failure to comply with treatment instructions or treatment failure could potentially explain prevalent STIs that were detected at follow-up. The low cure rates for chlamydial infection and trichomoniasis are cause for concern.